INTERGRATING TB/HIV INTERGRATING TB/HIV DATABASESDATABASES

Presenter:

DR. LAMECK DIERO

Presentation OutlinePresentation Outline

Introduction

AimsActivitiesChallenges

HIV/TB co-infected patients access care in two ways.

1) TB clinic patients test positive for HIV or 2) HIV-clinic patients are found to be infected with TB• Ideally services provided in these two clinics

should be well integratedHowever, communication between the two

clinics is often fragmented leading to disruptions of care and mismanagement of some co-infected patients

Introduction

Long term GoalsImprove delivery of patient careImprove staff efficiencyImprove reporting of public

health data to the Ministry of Health.

Specific AimsImplement TB EMR at MTRHLink the TB EMR to the existing

HIV/AIDS EMR◦ to improve integration and

monitoring of care of TB patients◦To increase the percentage of TB co

infected patients completing treatment

◦To increase the percent of TB patients referred to and retained by the HIV care program.

Specific AimsImplement the use of patient

summary sheets and clinical reminders◦To improve delivery of care◦To increase the % of TB patients

receiving appropriate AFB smear follow up after initiation of treatment

Project DesignAim 1: Implement the primary care

EMR◦Program the EMR into SQL programming

language to interface with AMRS◦Program expanded formats for TB into

the system◦Expanded Tb program to include

Patient identifiers, referral site, type of patient (eg smear positive, or smear negative), type of TB ( eg pulmonary or extra pulmonary), sputum smear results, culture results, X rays etc.

Project DesignAim 1

◦Train data management and entry staff

◦Patient registration into the system◦Develop pre-programmed queries to

generate monthly reports.

Project Design Aim 2: Link primary care EMR and existing

HIV/AIDS EMRAll patients presenting to the hospital are

enrolled in the system and given a unique patient ID number◦ By using unique identifiers that all patients within the

catchment's area are given Allows data sharing Allows better tracking of patients

◦ For TB care, it enhances the following Treatment completion

Completion of >95% of patients in the TB register. Successful completion of all recommended sputum

examinations Registration of TB patients into the TB care module

Achieve 100% registration

Project DesignAim 3: Implement use of

summary sheets and reminders◦These will highlight information key

to making treatment decisions◦Generate clinical reminders

Tests to be done Clinical parameters to be measured Treatments to be considered

◦Installation of local area networks in MTRH,

◦Installation of equipment i.e. computers, laminators, server, network, printers, etc.

◦Initiation of on-site data entry at the sites.

Completed tasks

◦Programming of TB encounter form◦Design of the universal ID’s◦Establishment of a patient registration

system at MTRH in-line with the Implementation process towards achieving a complete Medical Records System.

◦Initiated Electronic Medical Records for the TB Clinic.

Completed tasks [ cont..]

Sample Universal ID Card

Front Side

Back Side

AMRS TB Encounter Form

◦Trained over 100 records staff at MTRH on patient registration, data entry and terminal filing system.

◦Oriented all clinicians, nurses and lab technicians at the sites on the correct use of encounter forms.

Training

ProgressTotal number of 545 TB patients

registered ◦389 HIV co infected

Challenges Faced:Challenges Faced:Personnel challenges

◦Having to use records clerks at the facility rather than recruiting our own.

◦Using clerks with no prior computer training. ◦Having insufficient numbers of personnel.◦Attitudes of the personnel[resistance to

change and having the perception that system is burdensome and adds no value to their work]

◦Project inability to enforce rules and regulations on MoH staff.

◦Frequent transfer of trained staff

 

System challenges◦Programming of forms is a long and

tedious process that requires input from many stakeholders

◦Server and computer breakdowns ◦Frequent power shortages◦Balancing the use of the new

computerized system alongside the old manual system since both run concurrently at the onset.

Logistical challenges◦Fitting the whole process within the

hospital workflow with minimal changes to it.

Next stepsNext stepsComplete the development of the

decision support program (Ongoing).Initiate generation of enhanced

Patient Summary Reports with computer reminders at all project sites.

Conduct a satisfaction survey with health center personnel and administrators at each site

AcknowledgementsAcknowledgementsProject TeamCDCUSAID-AMPATHIeDEA